Provider Demographics
NPI:1649314980
Name:AZCARRAGA, MARIA BERNADETTE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:BERNADETTE
Last Name:AZCARRAGA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 MAPLE AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1734
Mailing Address - Country:US
Mailing Address - Phone:732-741-0678
Mailing Address - Fax:732-741-3939
Practice Address - Street 1:130 MAPLE AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1734
Practice Address - Country:US
Practice Address - Phone:732-741-0678
Practice Address - Fax:732-741-3939
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA00544800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077935Medicare ID - Type UnspecifiedPT